- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $945.00 / $3,570.00 / $10,893.00
| Facility | | $945.00 | $3,570.00 | $10,893.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,817.66 / $2,029.99 / $3,007.86
| Professional | | $1,817.66 | $2,029.99 | $3,007.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,774.76 / $2,260.40 / $3,206.86
| Professional | | $1,774.76 | $2,260.40 | $3,206.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,792.30 / $1,792.30 / $1,867.33
| Facility | | $1,792.30 | $1,792.30 | $1,867.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $900.00 / $2,258.30 / $4,619.00
| Facility | | $900.00 | $2,258.30 | $4,619.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,874.94 / $2,587.19 / $4,007.74
| Professional | | $1,874.94 | $2,587.19 | $4,007.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $55.00 / $17,791.12
| Facility | | $55.00 | $55.00 | $17,791.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13,931.28 / $14,252.48 / $17,061.30
| Professional | | $13,931.28 | $14,252.48 | $17,061.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,877.97 / $2,341.19 / $4,017.51
| Facility | | $1,877.97 | $2,341.19 | $4,017.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,217.78 / $2,950.61 / $3,471.30
| Professional | | $2,217.78 | $2,950.61 | $3,471.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,699.30 / $3,707.79 / $7,237.55
| Professional | | $1,699.30 | $3,707.79 | $7,237.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,878.34 / $2,353.51 / $4,457.68
| Facility | | $1,878.34 | $2,353.51 | $4,457.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,946.81 / $2,753.25 / $4,924.39
| Professional | | $1,946.81 | $2,753.25 | $4,924.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $385.00 / $1,970.00 / $8,583.00
| Facility | | $385.00 | $1,970.00 | $8,583.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,584.45 / $2,156.94 / $3,411.18
| Professional | | $1,584.45 | $2,156.94 | $3,411.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,645.92 / $1,912.03 / $2,578.42
| Professional | | $1,645.92 | $1,912.03 | $2,578.42 |